Practice Management Alert

Plus, welcome several new family history codes

Every fall, you-re faced with a slew of new diagnosis codes, and this year will be no different. Take a look at these highlights now to be sure you-re prepared by the time Oct. 1 rolls around, since there is no grace period.

Get Specific With New Lymphoma Codes

You should make sure your physician's documentation specifies the lymphoma type as well as the body part it affects. That information will be essential next fall.

The new ICD-9 diagnosis codes include lymphoma codes for:

- marginal zone lymphoma (200.30-200.38)
- mantle cell lymphoma (200.40-200.48)
- primary central nervous system lymphoma (200.50-200.58)
- anaplastic large cell lymphoma (200.60-200.68)
- large cell lymphoma (200.70-200.78)
- peripheral T-cell lymphoma (202.70-202.78).

For each category, you can specify whether the lymphoma is in the head, face or neck; the intrathoracic lymph nodes; the intra-abdominal lymph nodes; upper limb; lower limb; intrapelvic; spleen; or multiple sites.

Each lymphoma type requires a very different treatment, says independent consultant Margaret Hickey in New Orleans. So with these new, more specific diagnosis codes, you-ll have to be more careful to align each drug with the appropriate diagnosis code.

Good news: -The addition of all these lymphoma coding options is indeed big news for oncology coders,- says Cindy Parman, co-owner of Coding Strategies in Powder Springs, GA. -Lymphoma is one of the most challenging medical conditions [to code], because the existing ICD-9 code descriptors do not match current medical terminology used by the physicians who treat these conditions.-

Stop Using 787.2 for All Dysphagia Claims

October's update also gives five-digit codes to some categories, like dysphagia (787.20-787.29) or myotonic (359.21-359.29) conditions, whereas before you only had three or four digits.

In those cases, -we had a lot of conditions lumped together, and we just broke them out,- says Amy Blum, medical classification specialist with the National Center for Health Statistics, the part of the Centers for Disease Control and Prevention that develops new ICD-9 codes. More specific dysphagia codes will be useful to rehabilitation providers who work with a lot of post-stroke patients, she adds.

More: V84.8 (Genetic susceptibility to other disease) is going away, replaced with V84.81 (Genetic susceptibility to multiple endocrine neoplasia [MEN]) and V84.89 (... other disease).

The 2008 ICD-9 update also includes a number of new codes for family history and genetic predisposition for conditions such as malignant neoplasms, cardiovascular diseases and endocrine neoplasia. More and more patients come in for visits for these reasons, rather than because of any symptoms of their own, Blum says.

In addition:

- You-ll have four new codes for female genital carcinoma (233.30-233.39) and multiple endocrine neoplasia (MEN, 258.01-258.03).

- There are eight new herpes-related diagnosis codes (058.10-058.89). They allow you to specify types of infection between herpes 6, 7 or 8, plus herpes-related encephalitis.

- The new update revises 005.1 (Botulism food poisoning) and adds two new botulism codes: 040.41 (infant) and 040.42 (wound).

- Also, a handful of codes are revised, including 389.14 (Central hearing loss) and 389.18 (Sensorineural hearing loss, bilateral).